Metabolic dysfunction-associated steatotic liver disease (MASLD) affects multiple organs and aspects of your health. Because of this, taking care of yourself is a top priority. A complete care team can make a big difference in your health. Proper care can help reverse or slow down MASLD.
It’s important to learn about what goes into treating MASLD, which types of doctors and health care professionals you may need to visit, and how to make sure your care team meets your needs.
What Should I Know About MASLD?
MASLD, which used to be known as nonalcoholic fatty liver disease (NAFLD), occurs when too much fat builds up in your liver. It’s not caused by drinking alcohol like certain other liver diseases are.
There are two types of MASLD:
Simple fatty liver. This is when you have excess fat in your liver, but not inflammation or damage to its cells. Usually, this kind of MASLD doesn’t go on to cause liver damage.
Metabolic dysfunction-associated steatohepatitis (MASH). The severe form of MASLD is when you have inflammation in your liver (hepatitis), liver cell damage, and excess fat in your liver. The inflammation and cell damage can cause severe scarring (fibrosis), which can turn into scar tissue (cirrhosis).
About 25% of people globally have MASLD. Out of this group, about 6% have MASH.
Lifestyle factors (and other health conditions like obesity and diabetes) can increase your risk for MASLD. Race can also be a factor in how likely you are to develop MASLD. Hispanic ethnicity is a risk factor for developing MASLD.
How Is MASLD Treated?
Diet and exercise are the first line of treatment for MASLD. Medications and weight loss surgery can also help manage the condition.
There are limited medications that are approved to treat MASLD directly. Resmetirom (Rezdiffra) was the first FDA-approved medication to treat MASH. If you’re not able to take this medication, there are other things you can do to slow MASLD from getting worse – or even reverse it completely.
Left untreated, MASLD can damage your liver. As a result, you could be at risk for liver disease and cirrhosis, which means you’d need a liver transplant. But less than 3% of people with MASLD will need a transplant or die of complications from cirrhosis.
Who Should You Have on Your MASLD Care Team?
This disease is complex. You’ll likely need a variety of doctors to support you throughout your journey.
You may have a cardiac (heart) risk factor such as obesity, insulin residence, high blood pressure, high cholesterol levels, or diabetes. You may need doctors to treat those issues as well. Having these experts on your care team can also help your MASLD.
Primary care doctors
Your primary care doctor is a good place to receive care for MASLD. The doctor can screen for the disease and assist with treatment.
The American Association for the Study of Liver Diseases (AASLD), the American Association of Clinical Endocrinology (AACE), and the American Gastroenterological Association (AGA), among other groups, have created guidelines to help primary care doctors treat MASLD.
Seeing your primary care doctor is important to begin with. It’s also a good idea because you can have MASLD and not have any symptoms. If you’re a part of a high-risk group and are from Hispanic descent, it’s especially crucial to keep tabs on your liver health.
A primary care doctor can help you manage diabetes, high blood pressure, and high cholesterol if you have them. Of course, you may still want to see a specialist to receive care from someone who treats the disease more often. Tell your primary care doctor if you have MASLD. They can collaborate with any other specialists you see.
Hepatologists and gastroenterologists
Hepatologists are gastroenterologists. While a gastroenterologist can treat liver issues, hepatologists specialize in the treatment of your liver.
You may not see a liver doctor, or hepatologist, until your MASLD gets worse. In the meantime, you still may need care from other doctors.
A gastroenterologist can accurately diagnose MASLD and also help you treat it and its more advanced stage, called MASH.
Due to the high amount of MASLD cases and a shortage of hepatologists, gastroentertologists can play a useful role to support people with the disease.
Gastroenterologists can tell if other causes of liver disease are in play and they can tell if you have fibrosis. If you see a gastroenterologist and have severe fibrosis, they’ll most likely refer you to a hepatologist.
Cardiologists
If you have MASLD, you have a high risk for cardiovascular disease. A cardiologist can give you the necessary tests to help find out if you have any cardiovascular issues that may need special attention.
MASLD can lead to several cardiac conditions including:
Atherogenic dyslipidemia. When you have high triglycerides and low high-density lipoprotein cholesterol (HDL).
Atherogenesis. When plaques form in the arteries.
Diastolic dysfunction. A condition that affects how your heart can pump blood.
Valvular calcification. This happens when too much calcium builds up in your aortic valve. This valve connects the left side of your heart with your aorta (which is the large artery that carries blood through your body). Too much can narrow the valve and block blood flow (a condition called aortic valve stenosis).
Cardiac arrhythmias. These are irregular heartbeats.
Endocrinologists
Metabolic dysfunction and hormone issues can also play a part in MASLD. This is where an endocrinologist may come in. Research has shown that hormones like thyroid hormone and cortisol are linked to MASLD.
Diabetes is common in people with MASLD, too, and some data shows that having both diseases can make each other worse. Diabetes may also raise the risk for developing MASLD.
Obesity medicine doctors
Losing weight can be effective to reverse MASLD or keep it from becoming worse. Generally, losing about 10% of your body weight if you have overweight can lower your body fat and inflammation. This might help reduce scar tissue in your liver.
That’s why many people with MASLD turn to obesity medicine doctors. A bariatric surgeon or obesity medicine doctor can talk to you about weight loss surgery or taking a weight loss medication.
Nutritionists and dietitians
If you're on a path to lose weight, you’ll probably be changing your eating habits. Nutritionists and dietitians can advise you on changing your diet. Through this, they can help you lose weight.
Personal support
As you continue through your MASLD journey, leaning on family members and friends can help you reach your goals and maintain a healthy lifestyle. Don’t forget about getting help from others with the condition. The American Liver Foundation has an online support group.
What Can You Expect From Your MASLD Care Team?
Health care specialists will provide different functions. For instance, your cardiologist may work with you to manage high cholesterol or provide heart tests to gauge your cardiovascular function. An obesity medicine doctor can manage weight loss surgery or medication. A hepatologist would regularly manage your liver function tests and take into consideration other tests and reports from other members of your care team.
In addition to bloodwork, your care team may pay attention to your fibrosis 4 (FIB-4) index score. This is a liver fibrosis biomarker used in diagnosing and managing liver disease. Specifically, it can give you an idea of how much scarring has occurred in your liver. It can also tell you if you have a higher risk for advanced liver fibrosis, which may mean you need care from a hepatologist.
What Should You Look for in a Doctor?
Remember that your care team doesn’t only include healthcare professionals — you’re at the center of the team and are a part of it.
Your primary doctor can likely tell you if you should see a specialist. You can also opt to see a specialist without your primary care doctor’s recommendation. If you know you have aortic stenosis, for example, you may want to see a cardiologist.
Tips for finding a doctor that’s right for you:
- Ask friends for recommendations.
- Check with your insurance provider to see which health care professionals are in your network, and who’s not.
- Call your local hospital.
When you find a doctor, be sure to stay on top of your care. This can include keeping a journal of symptoms and staying on top of your labwork. If you think you want to get a second opinion, don’t hesitate.
Caring for MASLD often involves multiple doctors and experts. In addition, leaning on family, friends, and support groups can help you stay on track with your health goals.
Recap
- MASLD happens when fat builds up in your liver. This can lead to liver damage if untreated.
- A complete care team, which may include doctors for your liver, heart, and weight management, is very important for managing your condition and improving your health.
Show Sources
Photo Credit: DigitalVision/Getty Images
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